Background : Presentation of cardiac myxomas is quite variable and is affected by the site, size, and mobility of these tumours. This study was conducted to evaluate the relationship between the morphology of resected tumours and their clinical presentation and whether they have any influence on the decision of surgery.
Patients and Methods : Seventeen patients were operated upon for cardiac myxomas over a period of seven years (2003-2010). The majority of patients were females (65%). The age at presentation varied from 18-68 years (mean 42±13.8). The majority of tumours were located in the left atrium (n = 11). Other sites were the right atrium (n = 5) and the left ventricle (n = 1). The morphology of the resected tumours was evaluated regarding their size; number, shape and mobility.
Results : The majority of our patients represented with cardiac symptoms (59%), followed by constitutional manifestations (53%) and embolic episodes (12%). Preoperative diagnosis was established in 88% of cases by transthoracic echocardiography. The commonest site of attachment of tumours was interatrial septum (53%), while the remaining tumour originated from atrial wall, appendage and IVC. All tumours were solitary except the one originating from the left ventricle. 71% of tumours were rounded in shape and the rest were pedunculated. The size of tumors varied from 1.8-10 cm X 1-6 cm. All pedunculated tumors were symptomatic. On the other hand 3 patients who had rounded tumours were asymptomatic. Surgical excision was performed electively once the diagnosis was made, except in 6 patients who underwent emergency operation. Associated procedures in the form of tricuspid valve repair, mitral valve replacement, pulmonary embolectomy and CABG were performed in association with tumour excision.
Conclusions:
Presentation of cardiac myxomas is greatly affected by their morphology. This explains their variable symptomatology. In some cases, their diagnosis is missed because they are asymptomatic or masked by other associated lesions. Tumours originating from unusual sites and large tumours may necessitate modification of either bypass technique or surgical approach.
|
